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Potentially life-threatening emergency
Bowel perforation
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Potentially life-threatening emergency

Bowel perforation

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Contributors: Michael W. Winter MD, Christine Osborne MD, Nishant H. Patel MD, Desiree Rivera-Nieves MD, Khaled Bittar MD
Other Resources UpToDate PubMed

Synopsis

A bowel perforation refers to a rupture in the lumen of the small or large intestine. Perforations lead to intraperitoneal contamination with bowel contents and place patients at high risk for subsequent abscess formation, sepsis, and septic shock.

Causes of perforation include peptic ulcer disease (mostly duodenal), small and large bowel malignancies with tissue invasion, acute diverticulitis, acute appendicitis in the elderly population, inflammatory bowel disease, trauma, and ingestion of foreign bodies, or it may occur as a complication of endoscopic procedures.

Patients will typically present with abdominal pain as well as signs of severe inflammatory response syndrome (SIRS criteria). On examination, they may have an acute abdominal examination with a rigid abdomen and minimal to no bowel sounds, although the examination can be misleading and may be unremarkable.

The etiology of the perforation often depends on the history. Recent endoscopic procedures, known malignancies, prior bouts of diverticulitis, or a history of inflammatory bowel disease provide insight into the potential underlying cause of a perforation.

Codes

ICD10CM:
K63.1 – Perforation of intestine (nontraumatic)

SNOMEDCT:
235741002  – Perforation of small intestine
303078007 – Perforation of large intestine

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 11/29/2016
Last Updated: 11/29/2016
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Potentially life-threatening emergency
Bowel perforation
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Bowel perforation : Abdominal pain, Abdominal distension, Hypoactive bowel sounds
Imaging Studies image of Bowel perforation
Axial CT image demonstrates numerous foci of free intraperitoneal air secondary to a large bowel perforation (found intraoperatively).
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